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Let’s Reframe the Budget Debate: Don’t Continue to Chip Away at Our Mental Health System of Care

This guest post is written by Eric Arzubi, MD

istock children mental healthHow can there be any doubt today that our mental health system of care is broken?

Patients, their family members, advocates, and clinicians have known for a long time that we are experiencing a mental health crisis.  The Newtown tragedy is a gruesome and stark reminder that we have been sitting on the problem for too long.  Just last week, Governor Dan Malloy proposed a budget that sought additional cuts to mental health services and supports, including significant rollbacks to programs serving children and adolescents.

Mental illness is the biggest single cause of disability among developed countries.  Half of the entire U.S. population will struggle with mental illness at some point in their lives.  One-fifth of all children and adolescents currently have a diagnosable and treatable emotional-behavioral disorder; however, only one-fifth of THOSE youth can access the care they need.

Here’s a local take on those statistics.  About 110,000 of K-12 students in Connecticut, or 20% of all our state’s schoolchildren, currently have a mental illness.  Only 30,000 of those students can access the services they need and deserve, leaving 80,000 with untreated emotional-behavioral problems.

Incredibly, 80% of all pediatric mental health services and supports are delivered in the school setting, transforming our public schools into the de facto mental health system for youth.  That’s OK if we do everything we can to ensure that school-hired and school-based mental health professionals are equipped with the tools they need.  Sadly, Governor Malloy’s latest budget proposal looks to strip our front-line clinicians of desperately needed resources.

This is a health justice issue for a variety of reasons.  First, the Newtown shootings risk reinforcing stigma around mental illness.  The shooter is reported to have struggled with mental illness.  True or not, misinformed consumers of mass media might falsely jump to the conclusion that most people with psychiatric conditions are violent.  Most of us know that the mentally ill are much more likely to be victims of violence.

Second, if youth with psychiatric disorders are unable to access mental health services and supports, we know they are much more likely to experience school problems, beginning with a higher rate of suspensions and expulsions.  The situation is especially dire among minorities with mental illness.  For example, a recent study revealed that black, disabled middle school students in Connecticut had a 32% chance of being suspended or expelled over the course of a school year.  That number varied from town to town across the state, with Bridgeport posting a staggering 73% rate of suspensions and expulsions among black, disabled middle school students in a single school year.

I don’t mean to keep harping on Governor Malloy’s recent budget proposals.  He’s trying to solve a complex and growing financial problem; however, I find it hard to reconcile the incentives he gave a $130 billion hedge fund earlier this year with his recommendation to cut up to $1.5 million from the budget for school-based health centers in 2013.  In August, he announced $25 million in a forgivable loan and up to $80 million in urban renewal credits for Bridgewater Associates to move from Westport to Stamford.  Where’s the justice in that?

Pay close attention to the budget-related news that begins to emerge on December 19.  There will be lots of moving parts, but I encourage you to focus on at least one issue: school-based health centers, or SBHC’s.  They boost access to primary care and mental health services to children in a naturalistic setting, allowing clinicians to intervene early.  The budget passed in May 2012 included funds for 21 additional SBHC’s in Connecticut, allowing us to strengthen the system of care for our most vulnerable schoolchildren.  Please consider signing the following petition that calls for lawmakers to honor the budget as passed earlier this year:

Eric Arzubi ( Arzubi, MD, Co-Chair of the Keep the Promise Coalition, is a child and adolescent psychiatry fellow.



Image credit iStock Photos

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